A Business Model for Managing System Change Through Strategic Financing and Performance Indicators: A Case Study


This article describes how a system of care operated by a county government agency used a fiscal crisis as the opportunity
to reform its children’s system. A cross-system response to the crisis is outlined that includes a system of care framework
coupled with a business model, inter-departmental collaboration and leadership, the use of strategic reinvestment strategies,
and a quality improvement system that focuses on key indicators. Implementation of the system change is described with a specific
focus on cross-system entry points, financing strategies that re-allocate funds from deep-end programs to community-based
services, and management oversight through the use of performance indicators to monitor and support effectiveness. This article
examines the results of the system change, including the diversion of youth from system penetration, the reduction in residential
treatment bed days, the re-allocation of these savings to community-based services, and the outcomes of children who were
diverted from residential care and served in the community. The article offers a number of recommendations for other communities
contemplating system change.

  • Content Type Journal Article
  • Category original paper
  • Pages 1-9
  • DOI 10.1007/s10464-012-9512-z
  • Authors
    • Mary I. Armstrong, Department of Child and Family Studies, University of South Florida, 13301 Bruce B. Downs Boulevard, Tampa, FL 33612, USA
    • Heidi Milch, Community Connections of New York, Inc., 605 Niagara Street, Buffalo, NY 14201, USA
    • Peter Curtis, Erie County Department of Mental Health, 95 Franklin St., Room 1237, Buffalo, NY 14202, USA
    • Phillip Endress, Erie County Department of Mental Health, 95 Franklin St., Room 1237, Buffalo, NY 14202, USA
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